*Newdesh Dhal
*Post-graduate Resident, Lady Hardinge Medical College
A 45-year-old woman presents with palpitations, weight loss, and heat intolerance. On examination, she has a heart rate of 120 bpm and a diffusely enlarged thyroid gland. Her ECG shows atrial fibrillation with a rapid ventricular rate. What is the most appropriate initial treatment?
A.)Beta-blocker
B) Digoxin
C) Thyroidectomy
D) Methimazole
2.A 55-year-old diabetic male presents with a history of recurrent hypoglycemic episodes despite regular meals. On examination, he has a BMI of 32 kg/m². His fasting insulin levels are elevated, and a fasting glucose of 40 mg/dL is noted. What is the most likely diagnosis?
A) Insulinoma
B) Factitious insulin use
C) Addison’s disease
D) Non-functioning pancreatic tumor
3.A 25-year-old man presents with sudden-onset pleuritic chest pain and dyspnea. He has no significant past medical history. Examination reveals decreased breath sounds on the right side. A chest X-ray confirms a right-sided pneumothorax. What is the most appropriate initial management?
A) Needle aspiration
B) Chest tube placement
C) High-flow oxygen therapy
D) Observation
4.A 60-year-old man presents with headache, jaw claudication, and visual disturbances. ESR is elevated at 90 mm/hr. What is the most appropriate initial treatment?
A) Low-dose aspirin
B) High-dose prednisone
C) Methotrexate
D) IV Cyclophosphamide
5.A 40-year-old HIV-positive patient presents with a CD4 count of 80 cells/μL and progressive headache. MRI shows ring-enhancing lesions in the brain. What is the most likely diagnosis?
A) Tuberculosis
B) Cryptococcal meningitis
C) Toxoplasmosis
D) Progressive multifocal leukoencephalopathy
6.A 55-year-old man presents with sudden-onset chest pain radiating to the jaw, sweating, and nausea. His ECG shows ST-elevation in leads V1–V4. Troponin levels are elevated. Blood pressure is 90/60 mmHg, and heart sounds reveal a soft systolic murmur at the apex. What is the most likely complication?
A) Ventricular septal rupture
B) Cardiogenic shock
C) Papillary muscle rupture
D) Arrhythmias
7.A 35-year-old woman presents with recurrent episodes of palpitations, sweating, and headaches. Examination reveals a blood pressure of 180/110 mmHg. Laboratory investigations show elevated plasma meta-nephrines. What is the most appropriate next step in management?
A) Alpha-blockade with phenoxybenzamine
B) Beta-blockade with propranolol
C) CT/MRI of the adrenal glands
D) Surgical resection of the adrenal tumor
8.A 60-year-old woman presents with fatigue, weight loss, and constipation. On examination, she has a palpable goiter with bruits. Serum TSH is low, and free T4 is elevated. What is the most likely diagnosis?
A) Hashimoto’s thyroiditis
B) Graves’ disease
C) Subacute thyroiditis
D) Toxic multinodular goiter
9.A 50-year-old chronic smoker presents with a cough, hemoptysis, and weight loss. Chest X-ray shows a mass in the right upper lobe. What is the next best investigation?
A) Sputum cytology
B) CT-guided biopsy of the lung mass
C) Bronchoscopy with biopsy
D) PET-CT scan
10.A 25-year-old woman presents with weight gain, hirsutism, and irregular menstrual cycles. Physical examination shows truncal obesity, purple striae, and hypertension. What is the most specific diagnostic test for her condition?
A) Serum cortisol
B) ACTH levels
C) 24-hour urinary free cortisol
D) Dexamethasone suppression test
ANSWERS:
1). A, 2). A, 3). A, 4). B, 5.) C, 6.) B, 7.) A, 8.) D, 9.) C, 10.) C